More Than 1,400 Hospitals Penalized Under Readmissions Reduction Program

Thursday, December 27, 2012

More Than 1,400 Hospitals Penalized Under Readmissions Reduction Program

Medicare
is rewarding 1,557 hospitals with bonuses and reducing payments to 1,427 others
based on their readmission rates for heart attack, heart failure, and
pneumonia, says a Kaiser Health News article.

The biggest bonus is going to Treasure Valley Hospital, a physician-owned,
10-bed hospital in Boise, Idaho, that is getting a 0.83% increase in payment
for each Medicare patient. Auburn Community Hospital, a nonprofit near
Syracuse, New York, is facing the biggest cut, losing 0.9% of every payment.

On average, hospitals in Maine, Nebraska, South Dakota, Utah, and South
Carolina will fare the best. Hospitals in the District of Columbia,
Connecticut, New York, Wyoming, and Delaware are among the worst, the article
says.

Results for hospitals within the same system often varied. For instance, in
Rochester, Minnesota, the Mayo Clinic's Methodist Hospital will get a bonus.
But Mayo's flagship St Mary's Hospital, also in Rochester, will lose money.
Michael Rock, MD, an orthopedic surgeon at the Mayo Clinic, said that
Medicare's scoring system tends to favor hospitals such as Methodist, which
primarily does elective surgeries, over hospitals with lots of trauma and
emergency cases, which St Mary's handles.

Under the Affordable Care Act's Hospital Readmissions Reduction Program, Medicare will begin adjusting
payments next month through September 2013 and will retroactively apply the
changes to payments made in the last 3 months of this year.

The bonuses and penalties do not apply to money Medicare pays hospitals for
capital expenses, to teach residents, or to treat large numbers of low-income
patients. Hospitals with too few cases and ones that only offer specific
specialties, such as psychiatry, long-term care, rehabilitation, and cancer
treatment, are exempted. Maryland hospitals also are excluded because the state
has a unique reimbursement arrangement with the federal government.

In August,
Kaiser Health News reported that more
than 2,000 hospitals were expected to be penalized.

Physical
therapists can help serve an important role in patient care transitions and
care coordination and can help reduce readmissions by providing recommendations
for the most appropriate level of care to the health care team prior to and
during care transitions. For more information and to find clinical practice and
patient education resources to reduce readmissions, visit APTA's Hospital
Readmissions webpage.